Pharmacoeconomic evaluation of biosimilar recombinant alpha‑epoetin in the treatment of anemia in hemodialysis patients with chronic kidney disease

Written by Krysanov I.S., Ermakova V.Yu., Vaskova L.B., Tiapkina M.V.

  UDK: 616.155.154–02:616.61–002.2–085.357:658 | DOI: 10.17238/PmJ1609-1175.2019.1.50–56  Pages: 50–56 | Full text PDF | Open PDF 


Objective: The objective is to conduct a clinical and economic analysis of effectiveness of recombinant human erythropoietin (rhEPO), used to treat anemia in adult patients with dialysis-dependent terminal chronic kidney disease.
Methods: The study takes into account the direct medical costs of therapy with rhEPO: epoetin-alpha (Eralfon), darbepoetin-alpha (Aranesp) and epoetin-beta (methoxypolyethylene glycol, Mircera) for both intravenous and subcutaneous administration. A “cost minimization” analysis has been performed for equivalent doses of erythropoietin.
Results: With equal effectiveness of the studied drugs “Eralfon” 2500 IU intravenous turned out to be less expensive medicinal technology in relation to equivalent doses of “Aranesp” 20 μg and “Mircera” 75 μg and 75+50 μg – by 29 and 26 and 4 %, respectively. The transfer of patients to subcutaneous administration can reduce the weekly dose of epoetin-alpha by 20–30 % by reducing the frequency of taking the drug to twice a week, which reduces the cost of drug therapy. A subcutaneous administration of «Eralfon» 2500 IU is a cost-effective drug technology: savings can range from 58,380 to 117,156 rubles per patient per year.
Conclusions: Intravenous and subcutaneous administration of Eralfon 2500 IU can be considered more economical drug technology relative to Aranesp and Myrcera.

Links to authors:

I.S. Krysanov1, 2, V.Yu. Ermakova2, 3, L.B. Vaskova3, M.V. Tiapkina3
1 Medical Institute of Continuing Education, Moscow State University of Food Production (12 Vrubelya St. Moscow 125080 Russian Federation),
2 Institute of Clinico-Economic Expertise and Pharmacoeconomics (21 Novomytischinsky Ave. Mytischi 141008 Russian Federation),
3 Sechenov First Moscow State Medical University (8/2 Trubetskaya St. Moscow 119991 Russian Federation)

1. Clinical practical recommendations KDIGO on anemia in chronic kidney disease 2012 // Nephrology and Dialysis. 2013. Vol. 15, No. 1. P. 14–53.
2. National recommendations. Chronic kidney disease: the basic principles of screening, diagnosis, prevention and treatment approaches. St. Petersburg: Levsha, 2012. 54 p.
3. Updated Russian national guidelines for the diagnosis and treatment of anemia in chronic kidney disease in the 2014 edition. Moscow, 2014. 34 p. URL: http://nonr.ru/wp-content/ uploads/2013/11/Нац-Реком-Анемия-2014.pdf (date of access: 08.09.2018).
4. Amato L., Addis A., Saulle R. [et al.]. Comparative efficacy and safety in ESA biosimilars vs. originators in adults with chronic kidney disease: A systematic review and meta-analysis // J. Nephrol. 2018. Vol. 31, No. 3. P. 321–332.
5. Choi P., Farouk M., Manamley N. [et al.]. Dose conversion ratio in hemodialysis patients switched from darbepoetin alfa to PEGepoetin beta: AFFIRM study // Adv. Ther. 2013. Vol. 30, No. 11. P. 1007–1017.
6. Cuesta Grueso C., Poveda Andrés J.L., Garcia Pellicer J. [et al.]. Cost minimisation analysis for darbepoetin alpha vs. epoetin alpha in chronic kidney disease patients on haemodialysis // Farm. Hosp. 2010. Vol. 34, No. 2. P. 68–75.
7. Donck J., Gonzalez-Tabares L., Chanliau J. [et al.]. Preservation of anemia control and weekly ESA dosage after conversion from PEG-Epoetin Beta to Darbepoetin Alfa in adult hemodialysis patients: The TRANSFORM study // Advances in Therapy. 2014. Vol. 31, No. 11. P. 1155–1168.
8. Kuwahara M., Mandai S., Kasagi Y. [et al.]. Responsiveness to erythropoiesis-stimulating agents and renal survival in patients with chronic kidney disease // Clin. Exp. Nephrol. 2015. Vol. 19, No. 4. P. 598–605.
9. Palmer S.C., Saglimbene V., Craig J. [et al.]. Darbepoetin for the anaemia of chronic kidney disease // Cochrane Database Syst. Rev. 2014. Vol. 31, No. 3. CD009297.
10. Palmer S.C., Saglimbene V., Mavridis D. [et al.]. Erythropoiesisstimulating agents for anaemia in adults with chronic kidney disease: a network meta-analysis // Cochrane Database Syst. Rev. 2014. Vol. 8, No. 12. CD010590.
11. Raymond C.B., Wazny L.D., Vercaigne L.M. [et al.]. Conversion from epoetin alfa to darbepoetin alfa within the Manitoba Renal Program: Evaluation of dose ratios // CANNT J. 2008. Vol. 18, No. 1. P. 39–43.
12. Saglimbene V.M., Palmer S.C., Ruospo M. [et al.]. Continuous erythropoiesis receptor activator (CERA) for the anaemia of chronic kidney disease // Cochrane Database Syst. Rev. 2017. Vol. 7, No. 8. CD009904.
13. Sulowicz W., Locatelli F., Ryckelynck J.P. [et al.]. PROTOS Study Investigators. Once-monthly subcutaneous C.E.R.A. maintains stable hemoglobin control in patients with chronic kidney disease on dialysis and converted directly from epoetin one to three times weekly // Clin. J. Am. Soc. Nephrol. 2007 Vol. 2, No. 4. P. 637–646.
14. WHO EML 2016–2017: Application for erythropoietin-stimulating agents (erythropoietin type blood factors). WHO EML 2016–2017 – Erythropoietin-stimulating agents, December 2016.
15. Wilhelm-Leen E.R., Winkelmayer W.C. Mortality risk of darbepoetin alfa versus epoetin alfa in patients with CKD: systematic review and meta-analysis // Am. J. Kidney Dis. 2015. Vol. 66, No. 1. P. 69–74.


Founded in 1997  |  Editions in a year: 4, Articles in one issue: 30 |  ISSN of print version: 1609-1175  |  Ind.: 18410 (Agency "Rospechat’")  |  Edition: 1000 c.